Keynote: The power of community partnerships

Blandin Foundation CEO Kathy Annette keynote address to the 54th U.S. Public Health Service Scientific and Training Symposium, May 6, 2019.

 

Thank you for your kind words, Rear Admiral Taylor.

Distinguished guests.

Welcome to Minnesota!

Home of 10,000 lakes, 11 tribal nations, a strong educational system including University of Minnesota, Minnesota state system and 17 private colleges.

Mayo Clinic.  Twins.  Vikings…. And fishing (the season opener is in five days).

Duluth, Minneapolis, St. Paul, St. Cloud, Rochester and Moorhead – homes of “urban” citizens.  Greater Minnesota – our rural – home to more than 2 million people.

It is an honor to be with you tonight as president and CEO of Blandin Foundation.  Our foundation shares your passion for strong, healthy communities.  I also come to you as a one who has been on the ground with the corps during the worst of times, during tragedy.

Prior to joining the Blandin Foundation, I spent 26 years with the Indian Health Service.  I am well aware of the mission of the U.S. Public Health Service Commissioned Corps—“to protect, promote and advance the health and safety of the people of the United States.”

Our mission is similar … “to be a trusted partner and advocate to strengthen rural Minnesota communities, especially the Grand Rapids area (our home community in northern Minnesota).”

Throughout my career, I have been acutely aware of the importance of missions AND the need for partnerships to accomplish them.

As some of you may remember, 14 years ago a student at the Red Lake High School shot many people.  Red Lake Reservation is about 6 hours northwest of us right now.  The student killed his own grandfather, a teacher, a school security guard and five other students before killing himself afterward.

Because of my role at the Indian Health Service, I was assigned to help coordinate the local response.

At the time, I was the most senior federal health official who was geographically close. Plus, I happened not only to be Ojibwe but was raised on the Red Lake Reservation.  That was my high school.

I knew the families of so many who experienced losses that day, and the teacher who was killed.  Being a physician and having worked with the Red Lake reservation leadership for years helped.  I trusted the tribe would coalesce– and lead–and they trusted me.

There was so much to organize, but my most immediate role was to be there, to be home.  I remember being so very sad, attending so many funerals.

I will be ever grateful to all the partners who emerged to be with the tribe.  The US Public Health Service CO’s assigned to the Red Lake Hospital as physicians, nurses, dentists, pharmacists were among those first on the scene as they dealt with those who were shot, creating a temporary morgue in the library of the small hospital, starting to work through the grief of family and community members.

Within hours – other commissioned corps officers were on-site and taking on so many roles.  Other partners – from health providers, counselors, hospital staff temps, educators, law enforcement, communications specialists who worked with the tribe.   Philanthropic leaders came forward immediately – asking “how can we help?”

So many partners….  I cannot imagine the outcome if there had been no one to stand with the tribe.

Even in those days of terrible tragedy were the seeds of hope: the absolute commitment to protect the children, the urgency to get the school back together, to create a promising future.

Red Lake communities established youth leadership councils and strengthened the local Boys and Girls Clubs.  The tribe and partners took on drug and alcohol problems, youth leadership, even cancer prevention.

All elements of the community came together—tribal leadership, traditional healers, fire department, educators, the health care system–everyone.  We used what we’d learned about leadership during this horrendous tragedy to support the community as they healed and emerged stronger than before—resilient and hopeful.

Resilient and hopeful.

Tonight I focus my thoughts on partnership.  And how partnership leads to better outcomes.  And how the Minnesota experience is relevant nationally.

My organization, Blandin Foundation, has been working with rural communities for more than 75 years.  And I’m proud to say that Minnesota, including the tribal nations that share the same geography, can lean on strong rural networks – across the state, and among leaders within communities.

Depending on how you measure, about 40% of our population lives in communities of fewer than 35,000 people.  We call that rural.

Over those 75 years, we have learned many lessons about leadership.  One I would like to share tonight, because it is so key to partnership, is that in order for a community to change, it has to have hope.

Hope is believing that a different future is possible, for ourselves, those in our care, our communities.  Hope is being able to imagine what that future might be.  Wise leaders know that creating a shared vision for the future, a vision ARISING FROM and OF the community, is the engine that powers change.

As at Red Lake, when people have hope—and hopeful partners, they can accomplish amazing things.

 

Now, about that word “partner.”  Putting semantics aside, it is absolutely my experience – and I’ve had a lot of it – that partnership is not the creation of lock-step alliance.

Yes, great and wonderful things happen through alliances.  Even more is possible when people, organizations and communities stand WITH each other.

My bias may have been given to me at birth, when I was given the Ojibwe name of “Anna KOO ba day,” which means to “tie together.”  While as a child I wished it was something more like “rising sun” or “beautiful flower,” I see now the gift of this name.  Ann KOO ba day.  “tie together.”  Bridge. Bind.

Partnerships that last are tied together through relationship.  Being close enough to be able to see commonality, and also difference, and to appreciate it.  Also, being able to see and work with complexity.

 

I was a freshly minted family practice doc who landed in the heart of the Leech Lake Reservation.  At the time, things were pretty dark.  The neighboring border community, Deer River, saw very few Native students graduating from high school.   Fast-forward to today.  Deer River has gone from a Native American graduation rate of 30% to 80%.

This kind of impact takes systems and cultural change.  And we know that change happens along the lines of relationships, and happens at the speed of trust.

That’s exactly what the community of Deer River did.  They built the partnerships—with families, with administration, with the tribe, with the kids, with the faith community and businesses-–to put children at the center.  They also embraced cultural differences in deep and authentic ways.

This community not only created change, through partnership and embracing culture it allowed itself–and its systems–to be changed.  As a partner over many years, the Blandin Foundation has been honored to stand with them.

 

Speaking of change….  It was almost 40 years ago when I first entered medicine.  So much has changed.  Technological, pharmaceutical and other diagnostic advances and treatments that boggle one’s mind.

And, yet, in many ways we have come back to a place where we see health more holistically.  Strong communities see health in the context of the whole person, the whole community.  In philanthropy, we call this systems work.

We have found that a community is made up of 9 distinct, yet related, dimensions – from economic opportunity to life-long learning to spirituality and wellness.

It is in the balance of these dimensions that leads to a health community.  A strong community.

And a tremendous source of trusted partners.

Because when the community – or the person – is at the center, not our methodology, our practice, our mandate – so much more is possible.  We can see the range of systems at play.  At play in that place, for those people, for that person.  Thus, complexity – and, thus, the need for partners.

A very fresh example of this.

We have released the findings of a study that we have been conducting about every three years since 1998.

Called Rural Pulse, today this work actually looks at all Minnesotans, measuring how residents experience their communities and the state.  You’ve got days ahead of data and learning, so I won’t dwell on the huge body of details (all of which are available online; just google rural pulse).  But here are some headlines:

Among urban Minnesotans, which is about 60% of our state population, providing adequate health care services has leapt to the top of the list of important issues facing their communities since the last time we surveyed in early 2016.  Followed by elder care, mental health issues, affordable housing, roads and bridges, opioids and drug abuse.

One difference we found between urban and rural communities is persistent concern in Greater Minnesota still around the economy.  Even ahead of that, though, now is this same concern about whether or not the community is providing adequate health care services – 87% name that as an important community issue.  Not far behind are elder care, local job opportunities, opioids and drug abuse, mental health issues and economic development.

In other words, strengthening communities is complex work.  Health care delivery is a piece—clearly a big piece—and yet with this kind of systems work, pulling on one thread leads to the need to pull on another.

And, to get it right, to be effective, context matters.  I wish there was a one-size-fits-all way – like a checklist.  Do these things and you’ll have a healthy community.  We’ve tried.  Culture and context always drive.

So, with 80 percent of the country’s main streets – a proxy for infrastructure – in rural places, I believe it is imperative to also understand systems work – partnership work – in these often-remote places.

Which brings me back to the story of Red Lake.  On paper, it may have been difficult to see a path forward to healing.  But by staying humble, listening, watching for community assets, investing in relationships on the ground and finding trusted intermediaries, standing with them.  Impact is seen.

As often is said, “If you want to go fast, go alone.  If you want to go far, go together.”

I see that happening around the 2020 Census in our state.  Thank goodness, because it’s critically important that we do what it takes for a full and fair count.  Too many are continually uncounted, leaving voices unheard, needs underestimated and underfunded, skewing where our country places investments like housing and hospitals – even Walmarts.

Minnesota decided to pull together to do a better job of getting everyone counted in this next Census.  I’m so delighted to see Mayor “Fry” here tonight, as the city of Minneapolis is one of our many partners in the Minnesota Census Mobilization Partnership.

A partnership dedicated to co-creating strategies WITH those traditionally undercounted, not FOR.

Wow!  What a difference!

By setting our own frames aside, we learned that many simply didn’t know what the Census was, why it’s done, when it’s done, how it’s used and what impact it has on the well-being of the community.

We found that fear is real.  There is serious apprehension that causes some to avoid participating in the Census.  Strangers knocking on the door, privacy concerns.

We also found that members of undercounted communities were excited and energized when they understood what was at stake in the Census.  Overwhelmingly, they said they wanted the Census to be done in service of advancing the best interests of their community, instead of Census being done to them.

Their passion and commitment to their communities and their own leadership outweighed the fear of harm, and they are eager to make the Census a tool for their own advancement.

By sitting at tables together, we learned these and other insights.  And, now, we have the relationships to mobilize resources WITH those we mean to serve.  To share power.

Here are some of the best practices we used to get here.  I believe they are highly relevant in the public health context as well, because so many of our country’s big public health advances have taken similar approaches (tobacco, HIV, teenage pregnancy):

  • Practice cultural humility and acknowledge the historical context from which mistrust and tension stems.
  • Use an asset approach; acknowledge community strengths and build from there.
  • Openly discuss expectations, values, purpose and roles.
  • Approach collaboration as part of a long-term relationship. Remember, change breaks along the lines of RELATIONSHIPS and happens at the speed of TRUST
  • Keep focused on doing WITH, not FOR or TO.
  • Expect tension as new and critical relationships are established; courageous conversations will be needed.
  • Plan for balancing power.

This Census work has renewed my belief that we can tackle even the most complex challenges.  And, I have to say, Minnesotans are very optimistic, even in difficult times.

Every community has assets.  Every place has a way to get things done – because they have to.  Because it’s about their neighbors.  In rural places, those are the same neighbors that they see at the grocery store, or in church, at a cultural event or their kids play together.

Whether it’s the Census – or opioids, or mental health issues, or the economy, or housing – there’s always possibility.  Hope and concern.  Side by side.

Powerful solutions through systemic approaches, sometimes tackling multiple systems at once.  And possibilities unlocked through partnership.

 

It has been my great pleasure to be invited into your midst this evening.  My hope is that you feel even more encouraged to explore partnerships as you take on your critically important work.  And that you can imagine new sources of relationships to make the kinds of systems changes that our complex world today demands.

Thank you for your service on behalf of our country.